Provider Demographics
NPI:1912283615
Name:LA, DEREK OAI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:OAI
Last Name:LA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6762 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3184
Mailing Address - Country:US
Mailing Address - Phone:714-209-2877
Mailing Address - Fax:
Practice Address - Street 1:6762 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-3184
Practice Address - Country:US
Practice Address - Phone:714-209-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist